
New research from Health Affairs is bolstering an already ongoing concerns over that the consolidation of physician practices may allow providers with greater market power to charge higher prices without having to deliver better care.
Patients of high-price practices did report higher scores on certain measures of care coordination and management. But there was little difference between high and low-price providers when it came to overall care ratings, acute care use, receipt of preventative services, total Medicare spending and other aspects of patient experience, such as physician ratings and access.
A possible reason, according to the study, is that providers with greater market power, and limited competition, may be able to charge substantially higher prices in part because health insurance largely shields patients from the costs of their care. Plus, patients may not always be able to distinguish between good and bad quality.
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The research did find evidence that larger and high-price practices have more advanced systems to support care coordination and management, both on Consumer Assessment of Healthcare Providers and Systems measures and in their engagement in Medicare programs promoting quality reporting and electronic health record development.
But the findings also showed that practices don't achieve greater economy of scale beyond modest size thresholds. Specifically, prices that are higher than average for any given area weren't associated with better performance, suggesting that provider organizations with the market power to snag high prices performed no better than the typical average-priced practice.
Moreover, the enhanced care coordination and management exhibited by some high-price practices didn't extend to other aspects of quality, such as access and the use of potentially preventable acute care.
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The study examined these findings in the context of fee-for-service payment, and some industry stakeholders have suggested that larger and higher-priced providers could leverage their structural capabilities to deliver better and more efficient care under newer, value-based payment models.
To date, however, there's been no evidence pricier providers have been more responsive than less expensive ones when it comes to these new models, according to the study.
Twitter: @JELagasse